Association of Hospital Resource Utilization With Neurodevelopmental Outcomes in Neonates With Hypoxic-Ischemic Encephalopathy
Authors: Vilmaris Quinones Cardona, Rakesh Rao, Isabella Zaniletti, Priscilla Joe, Yvette R. Johnson, Robert DiGeronimo, Shannon E. Hamrick, Kyong-Soon Lee, Ulrike Mietzsch, Girija Natarajan, Eric S. Peeples, Tai-Wei Wu, Tanzeema Hossain, John Flibotte, Amit Chandel, Amy Distler, Jeffrey S. Shenberger, Onome Oghifobibi, An N. Massaro, Maria L. V. Dizon, Nathalie Maitre, Amit Mathur, Eugenia Pallotto, Danielle Smith, Mark Speziale, Toby Yanowitz, Beverly Brozanski, Jacquelyn Evans, Theresa Grover, Karna Murthy, Michael Padula, Anthony Piazza, Kristina Reber, Billie Short, David Durand, Francine Dykes, Jeanette Asselin, Kevin Sullivan, Victor McKay, Jamie Limjoco, Lori Haack, Narenda Dereddy, Raj Wadhawan, Gustave Falciglia, Becky Rogers, Anne Hansen, Cherrie Welch, Beth Haberman, Gregory Sysyn, Nicole Birge, THeresa Grover, Michel Mikhael, Irfan Ahmad, David Munson, Michael Uhing, Ankur Datta, Rashmin Savani, Luc Brion, Julie Weiner, Lamia Soghier, Carl Coghill, Allison Black, Steven Chin, Rachel Chapman, AnneMarie Golioto, Jonathan Nedrelow, Annie Chi, Yvette Johnson, Mark Weems, Aaron Weiss, Trent Tripple, Con Yee Ling, Shrena Patel, Brian Lane, Laurel Moyer, William Engle, Lora Simpson, Gregory Sokol, Elizabeth Jacobsen-Misbe, Julie Lindower, Gautham Suresh, Lakshmi Khatakam, Art D'Harlingue
Journal: JAMA Network Open (2023)

Intercenter variation exists in the management of hypoxic-ischemic encephalopathy (HIE). It is unclear whether increased resource utilization translates into improved neurodevelopmental outcomes.To determine if higher resource utilization during the first 4 days of age, quantified by hospital costs, is associated with survival without neurodevelopmental impairment (NDI) among infants with HIE.Retrospective cohort analysis of neonates with HIE who underwent therapeutic hypothermia (TH) at US children's hospitals participating in the Children's Hospitals Neonatal Database between 2010 and 2016. Data were analyzed from December 2021 to December 2022.Infants who survived to 4 days of age and had neurodevelopmental outcomes assessed at greater than 11 months of age were divided into 2 groups: (1) death or NDI and (2) survived without NDI. Resource utilization was defined as costs of hospitalization including neonatal neurocritical care (NNCC). Data were linked with Pediatric Health Information Systems to quantify standardized costs by terciles.The main outcome was death or NDI. Characteristics, outcomes, hospitalization, and NNCC costs were compared.Among the 381 patients who were included, median (IQR) gestational age was 39 (38-40) weeks; maternal race included 79 (20.7%) Black mothers, 237 (62.2%) White mothers, and 58 (15.2%) mothers with other race; 80 (21%) died, 64 (17%) survived with NDI (combined death or NDI group: 144 patients [38%]), and 237 (62%) survived without NDI. The combined death or NDI group had a higher rate of infants with Apgar score at 10 minutes less than or equal to 5 (65.3% [94 of 144] vs 39.7% [94 of 237]; P < .001) and a lower rate of infants with mild or moderate HIE (36.1% [52 of 144] vs 82.3% [195 of 237]; P < .001) compared with the survived without NDI group. Compared with low-cost centers, there was no association between high- or medium-hospitalization cost centers and death or NDI. High- and medium-EEG cost centers had lower odds of death or NDI compared with low-cost centers (high vs low: OR, 0.30 [95% CI, 0.16-0.57]; medium vs low: OR, 0.29 [95% CI, 0.13-0.62]). High- and medium-laboratory cost centers had higher odds of death or NDI compared with low-cost centers (high vs low: OR, 2.35 [95% CI, 1.19-4.66]; medium vs low: OR, 1.93 [95% CI, 1.07-3.47]). High-antiseizure medication cost centers had higher odds of death or NDI compared with low-cost centers (high vs. low: OR, 3.72 [95% CI, 1.51-9.18]; medium vs low: OR, 1.56 [95% CI, 0.71-3.42]).Hospitalization costs during the first 4 days of age in neonates with HIE treated with TH were not associated with neurodevelopmental outcomes. Higher EEG costs were associated with lower odds of death or NDI yet higher laboratory and antiseizure medication costs were not. These findings serve as first steps toward identifying aspects of NNCC that are associated with outcomes.